Big picture challenges

The CfWI's big picture challenges are complex high-level challenges facing policymakers in health, social care and public health. For more information, please see our report on the implications of the challenges for education and training.

Click on the icons for more information about each of our big picture challenges. Alternatively, choose from the four categories below.

Planning to meet the needs of an ageing population with an ageing workforce

It is vital to understand the changing needs of the population and how the workforce will need to change to ensure services meet these needs. The challenge also touches upon other areas associated with the ageing population, such as the fact that the workforce will also be ageing, and that the dependency ratio will decrease. This could place further financial pressure on public sector budgets and heighten the resource constraints in which the workforce operates.

Older people are much more likely to have long-term conditions. They are also more likely to have multiple conditions which can increase the complexity of care required. Increasing obesity and unhealthy lifestyles among younger age groups could change the services people will demand as they ‘store up problems for the future’. It has been projected that the number in the UK with dementia will double in the next 40 years (Alzheimer’s Society, 2012) and that one out of every three people over the age of 65 will develop dementia. It is important to understand which conditions will be prevalent in the future, as this will influence the workforce required to deliver care. Multimorbidity, and the ability of the health and social care workforce and patients to balance the benefits and risks of multiple treatments and services (Guthrie, 2012), presents a challenge to the single-disease framework of most healthcare and medical education (Barnett, 2012).

Managing changing public expectations

The public has access to more information about conditions and available services. Some are becoming empowered to make demands about the treatment they receive and how their care is delivered. They increasingly expect access to the latest technology and medical advances. Demands for 24/7 care and the improved measurement and public accountability of patient experience (The Richmond Group of Charities and The King’s Fund, 2012) are examples of the changing expectations that groups have of modern services.

This challenge will cover the workforce implications of an ‘informed public’ and the change required to manage public expectations in a resource constrained system.

Achieving better integration between health, social care and support organisations

One of the current aims, and challenges, is how to achieve better integration between health, social care and support organisations. The system has been trying to integrate for decades but has yet to achieve any real progress. Integration aims to deliver a number of benefits, including being a more cost-effective way to deliver care. An increasing number of patients have complex co-morbidities, so professionals will need to work in an integrated way and across organisation boundaries to ensure that patients’ needs are met and that care is delivered in a joined-up and holistic way. Despite this, however, the system is still disputing what is truly implied by ‘integration’ and what needs to be done to finally achieve it.

Shifting the focus of the system towards prevention and well-being

Shifting the focus towards prevention and well-being could help to address a number of the demographic and financial big picture challenges. By focusing on preventive services, and avoiding the development or deterioration of long-term conditions, expensive treatment and care options can be avoided in the future. This will decrease demand and free up resources for those who really need them. Shifting towards prevention will be a key challenge for a system that has always focused on treating those who are ill, rather than helping the population to stay healthy. This can significantly alter the requirements of the health and social care workforce as it will impact on the level of health need.

The shift towards prevention aligns with the Government’s personalisation agenda and a drive to encourage self management and self-care to shift some of the responsibility for health and social care from the state to the individual. The Government report No Decision About me Without me (Department of Health, 2012a) puts forward an ambition to empower patients to take more of a role in their own care, making patient choice central to decisions about treatment and care. Giving people access to appropriate information will be key to achieving this. The health and care workforce will have to be equipped to manage changing demand for service and increasing public expectations about care choices.

Ensuring the system delivers high-quality services within financial constraints

The health and social care system has always aimed to deliver high-quality services, but this needs to be balanced with the resources that are available. How we deliver high-quality future care, and understanding the workforce’s role in achieving this, is a key challenge. We must understand the need for investment in new technology and innovations to improve quality and productivity and allow for more time to care. We also need to ensure that funding and outcome-based incentives are aligned to promote high-quality care and innovation, and do not encourage perverse incentives that shape behaviour.

Collecting high quality data to effectively measure quality of care and productivity

We need to measure quality of care and productivity effectively, so it is possible to demonstrate improvements in the system. For example, how do we know this way of doing it is better? This will need to include quality standards (what is ‘good’), how they are measured, and how to demonstrate the value of the workforce. We will need to ensure that data is of a high quality and that it is valid and reliable.

Preparing for changes resulting from innovation and technology

Significant changes to health and social care services, and the way the workforce operates, often result from innovation such as technological developments or scientific advancements in treatments. Anticipating what innovative changes may become operational in the future will be important for ensuring the system and the workforce are adequately prepared to take advantage of the opportunity to improve quality and productivity.

Planning service delivery given the uncertainty about level of funding in the future

It is clear that public sector budgets will remain constrained for a number of years. This is likely to continue to affect spend on health, social care and public health for at least the next 10 years. Looking further into the future (+10 years) there is a wider range of possible scenarios for financing the system. There is uncertainty about whether self-funding will begin to play a larger role, and about what the implications of a mixed economy provision will be. How will this change demand and for health and care service? The need to ensure the financial sustainability of providers and the workforce impact of this is also a topic that is beginning to be debated.

Uncertainty about how investment in life science, health and care will support the UK economy

The UK currently has one of the world’s strongest and most productive life science economies. In 2009, £4.4 billion was spent on pharmaceutical research and development in the UK. Medical technology and biotechnology sectors also had an annual turnover of around £18.4 billion. The Government has put measures in place to ensure that the UK remains a globally competitive environment (UK Trade and Investment, 2012). It is currently unclear how this investment in science and technology will impact on treating long-term conditions. If these investments are able to support people with long-term conditions to stay healthier for longer, there may be significant impacts on the number and types of health and care services required for the future.